Cardiology Coding Alert

Cardiology coders may not be very concerned about the most recent Correct Coding Initiative (CCI) edits, but they could hit snags if they don't pay attention to bundled work in the new biventricular codes.

The most recent CCI edits version 9.0, effective Jan. 1 through March 31 add the new CPT code 64416 (Injection, anesthetic agent; brachial plexus, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) to all categories of cardiovascular system codes.

You should use 64416 when reporting procedures that include injecting an anesthetic agent into the appropriate somatic nerve. This code has a 10-day global period and includes the provider's services for daily, continuous drug administration to the brachial plexus for postoperative pain control, says Martha Gerant, CPC, professional coder and reimbursement specialist for Cardiology Services in Olathe, Kan.

Under CCI 9.0, the new and revised pacemaker codes include anesthesia codes for pacemaker placement, left ventricular pacing placement, introduction of needle and venipuncture, transcatheter therapy, injection and continuous infusion, anesthetic agent injection, microsurgical techniques, and intravenous infusion.

Take note that the new codes also include device implantation work that you previously reported separately.

For instance, in addition to the anesthesia and venipuncture codes, 33224 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing ...) includes 33222 for revision or relocation of skin pocket for pacemaker, 33223 for revision of skin pocket for a cardioverter-defibrillator, 33233 for removal of permanent pacemaker pulse generator, and 33240 for insertion of a cardioverter pulse generator.

Revised code 33216 (Insertion of a transvenous electrode; single chamber ...) now includes 64416 for nerve block anesthesia.

The new CCI edits for the septal defect repair codes, 93580 (Percutaneous transcatheter closure of congenital interatrial communication [i.e., fontan fenestration, atrial septal defect] with implant) and 93581 (Percutaneous transcatheter closure of a congenital ventricular septal defect with implant), also bundle a number of procedures.

The edits include anesthesia codes, introduction of needle or intracatheter of the extremity artery, transcatheter therapy for infusion, intravenous infusion, and the cardiac catheterization series codes starting with 93501.

Coders should pay particular attention to whether the physician performs a cardiac catheterization as part of the repair, Gerant says. If you report the catheterization separately at the time of the septal defect repair, payers may consider it unbundling.

Another thing to watch for is the use of modifier -59 (Distinct procedural service) with 93580 and 93581. CCI bundles the cardiac catheterization codes with 93580-93581, which have a 0 subscript in the edits, indicating that you should not append modifier -59.

CCI 9.0 bundles 76986 (Ultrasonic guidance, intraop-erative) with the echocardiography codes, starting with 93303. If the ultrasonic guidance is a separate and distinct procedure, CCI dictates that you can append modifier -59, but documentation must support the use of this modifier, Gerant says. The noninvasive vascular diagnostic studies starting with 93875 also include 76986.